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OCR for page 32
32 State level coordination--Coordination of services between NEMT and public transit. Research could occurs at the local level, whether the state agencies have identify NEMT and public transit safety and quality coordinated or not. This is seen in states where there is standards and activities that can "level the playing an indifference to coordination at the state level and field." Areas for research include reviewing NEMT and even where the state is resistant to coordination. Unfor- public transit safety (e.g., accidents, incidents, and tunately, coordination is far less likely when the state training) and quality (e.g., on-time, missed trips, vehi- agencies are not cooperating. cle breakdowns, and driver experience). Cost transferring--Cost transferring typically occurs when an NEMT program decides to shift its paratransit CHALLENGES riders to the general public ADA service; shifting the burden of funding NEMT from the state Medicaid There are some activities and policies that are clear impedi- agency to the local transit agency. Research could iden- ments or barriers to coordination. Where these are in place, tify how widespread this practice is, who benefits, and coordination is more difficult. who pays for this approach. The research could identify a policy to address this issue as well. Cost transferring--One large broker reported that it Use of fixed-route service--Fixed-route service is clearly was its intention (in a state not reviewed in this synthe- beneficial for clients, NEMT, and public transit. Research sis) to transfer as many clients to American with Dis- might help identify where this practice is used and how abilities Act (ADA) paratransit as possible; shifting the other states could increase their use of fixed-route service. financial burden from the broker to public transporta- It would also be helpful to NEMT program managers in tion and local taxpayers. This is the direct opposite of understanding how customers can be identified as being coordination and will only result in distrust. able to use fixed-route service (something ADA agencies Jurisdictional--Medicaid trips by nature often require have been perfecting over the past 15 years). long distance transportation for specialty medical Tools and strategies for local level coordination--More needs, crossing transit jurisdictional lines. Some opera- national research is needed on how to coordinate at the tors have cited (local level) problems with the crossing local level. How do successful managers of coordinated of jurisdictional lines. agencies build trust, operate service, and manage mul- Freedom of choice--The Medicaid Freedom of Choice tiple funding sources? requirement treats transportation as it would a medical Education for leaders/policy makers--NEMT and pub- program, allowing customers to use any provider they lic transit are very specialized programs. Frequently, choose. Furthermore, this approach makes coordination the managers of these programs are not well versed in problematic by encouraging more small providers. the issues and needs of the other program. A national forum could be developed to identify the concerns, pro- SUGGESTIONS FOR FURTHER RESEARCH vide the necessary dialogue, and educate leaders of both communities. Local elected officials should also be Based on the surveys, literature review, case studies, and involved in this effort. first-hand observation, coordination can happen in most set- Efforts geared toward communication and trust--The tings. It is evident that further research to facilitate actual importance of local level coordination cannot be over- NEMT coordination at the transit agency level is necessary stated. Research can help identify how trust can be built in a number of areas. The following issues can be viewed as and maintained. starting points for in-depth research: Freedom of choice--The freedom of choice requirement for transit is not equivalent to the choice of medical pro- Identification of uniform service standards--One of fessionals. Research should look into the effectiveness of the primary observations of this study is the difficulty this requirement for transit--an industry that is not as in coordinating when service standards are different closely regulated as for example the medical profession.